Celiac disease is acondition that damagesthe lining of the smallintestine and prevents itfrom absorbing parts offood that are importantfor staying healthy. Thedamage is due to areaction to eatinggluten, which is found inwheat, barley, rye, andpossibly oats.
Causes, incidence, and risk factorsThe exact cause of celiac disease is unknown. The lining ofthe intestines contains areas called villi, which help absorbnutrients. When people with celiac disease eat foods oruse products that contain gluten, their immune systemreacts by damaging these villi.This damage affects the ability to absorb nutrientsproperly. A person becomes malnourished, no matter howmuch food he or she eats.The disease can develop at any point in life, from infancyto late adulthood.People who have a family member with celiac disease areat greater risk for developing the disease. The disorder ismost common in Caucasians and persons of Europeanancestry. Women are affected more often than men.
Figure 1: Healthy villi of Figure 3: Villi completely Figure 2: Damaged villi of thethe small intestine seen destroyed by the immune small intestine.under the microscope. system.
People with celiac disease are more likely to have: Autoimmune disorders such as rheumatoid arthritis,systemic lupus erythematosus Jorgen syndromeAddisons diseaseDown syndromeIntestinal cancerIntestinal lymphomaLactose intoleranceThyroid diseaseType 1 diabetes
SymptomsThe symptoms of celiac disease can be different from person toperson. This is part of the reason why the diagnosis is not alwaysmade right away. For example, one person may have constipation, asecond may have diarrhea, and a third may have no problem withstools. Gastrointestinal symptoms include:Abdominal pain, bloating, gas, or indigestionConstipationDecreased appetite (may also be increased or unchanged)Diarrhea, either constant or off and onLactose intolerance (common when the person is diagnosed, usuallygoes away after treatment)Nausea and vomitingStools that float, are foul smelling, bloody, or “fatty”Unexplained weight loss (although people can be overweight or ofnormal weight)
Because the intestines do not absorb many importantvitamins, minerals, and other parts of food, the followingsymptoms may start over time:Bruising easilyDepression or anxietyFatigueGrowth delay in childrenHair lossItchy skin (dermatitis herpetiformis)Missed menstrual periodsMouth ulcersMuscle cramps and joint painNosebleedsSeizuresTingling or numbness in the hands or feetUnexplained short height
Children with celiac disease may have:Defects in the tooth enamel and changes in tooth colorDelayed pubertyDiarrhea, constipation, fatty or foul-smelling stools, nausea,or vomitingIrritable and fussy behaviorPoor weight gainSlowed growth and shorter than normal height for their age
Signs and testsAlbumin (may be low)Alkaline phosphates (high level may be a sign of bone loss)Clotting factor abnormalitiesCholesterol (may be low)Complete blood count (CBC - test for anemia)Liver enzymes (transaminases)Prothrombin timeBlood tests can detect several special antibodies, called ant tissue transglutaminaseantibodies (tTGA) or anti-endomysium antibodies (EMA). The health care provider willorder these antibody tests if celiac disease is suspected.If the tests are positive, upper endoscopy is usually performed to sample a piece oftissue (biopsy) from the first part of the small intestine (duodenum). The biopsy mayshow a flattening of the villi in the parts of the intestine below the duodenum.Genetic testing of the blood is also available to help determine who may be at risk forceliac disease.A follow-up biopsy or blood test may be ordered several months after the diagnosisand treatment. These tests evaluate your response to treatment. Normal results meanthat you have responded to treatment, which confirms the diagnosis. However, thisdoes not mean that the disease has been cured.
TREATMENTCeliac disease cannot be cured. However, your symptoms will go away and the villi inthe lining of the intestines will heal if you follow a lifelong gluten-free diet. Do not eatfoods, beverages, and medications that contain wheat, barley, rye, and possibly oats.You must read food and medication labels carefully to look for hidden sources of thesegrains and ingredients related to them. Because wheat and barley grains are commonin the American diet, sticking with this diet is challenging. With education andplanning, you will heal.You should NOT begin the gluten-free diet before you are diagnosed. Starting the dietwill affect testing for the disease.The health care provider may prescribe vitamin and mineral supplements to correctnutritional deficiencies. Occasionally, corticosteroids (such as prednisone) may also beprescribed for short-term use or if you have sprue that does not respond to treatment.Following a well-balanced, gluten-free diet is generally the only treatment you need tostay well.When you are diagnosed, get help from a registered dietitian who specializes in celiacdisease and the gluten-free diet. A support group may also help you cope with thedisease and diet.
Expectations (prognosis)Following a gluten-free diet heals the damage to the intestines and prevents further damage.This healing most often occurs within 3 - 6 months in children, but it may take 2 - 3 years inadults.Rarely, long-term damage will be done to the lining of the intestines before the diagnosis ismade.Some problems caused by celiac disease may not improve, such as a shorter than expectedheight and damage to the teeth. ComplicationsYou must carefully continue to follow the gluten-free diet. When untreated, the disease cancause life-threatening complications.Delaying diagnosis or not following the diet puts you at risk for related conditions such as:Autoimmune disordersBone disease (osteoporosis, kyphoscoliosis, fractures)Certain types of intestinal cancerLow blood count (anemia)Low blood sugar (hypoglycemia)Infertility or repeated miscarriageLiver disease
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